Tag: Healthcare Trends

Before the invention of the stethoscope, doctors routinely laid their ears on chests of patients to check how they were doing. Homemade concoctions, essentially placebos, often made people feel better. Doctors visited homes of patients who would later pay them whatever they could afford. Local apothecaries sold morphine, a derivative of opium, to reduce pain. Medicine for its part was a nascent science – most of today’s diseases were yet to be discovered.

Fast forward to today, healthcare is a multi-trillion dollar industry. Medicine has branched into 120 recognized specialties and subspecialties, spinning out several industries like pharma, biotechnology, medical devices and so on with billions of drugs prescribed and lab tests performed every year. Medicine is no longer within the domain of the doctor and patient – it’s a science with ever increasing complexity.

While this advancement has helped in doubling our life expectancy in the last 100 years, the complexity of our healthcare system is hurting more than helping.

The demand for specialists is so high that they are unable to invest the time required to identify or address the root cause of why the patient has fallen sick, which could depend on factors such as the environment where she lives. Further, the patient is prescribed drugs that often have interactions with those prescribed by some other specialist, inadvertently making patients sicker. In a world of quick everything, neither the doctor nor the patient is able to go beyond fixing the problem at hand.

It’s difficult to keep solving underlying problems of sickness when the industry is paid based on the quantity of care delivered. A doctor gets paid more if he performs more procedures or sees more patients, not if he keeps a thousand people healthy. Most patients today would leave a doctor’s office dissatisfied if they aren’t prescribed a drug or made to go through a lab examination. The result is a business that wants to make a patient feel better for the short-term by doing something because that’s what the customer appreciates.

At an earlier time, patients visited doctors to fix conditions that were gross and obvious like broken hands. But now our expectations have changed. We want everything fixed so that we don’t have to compromise on our desires whatever those may be. But the more we understand the workings of our body, the more we discover how little we know. The quick-fix approach to medicine fails badly because we are trying to fix a constantly evolving target – our body.

While we spend billions of dollars on human genetics, we hardly know much about our microbiome or the genome of our bacteria. Only recently we learnt that 90% of our cells is microbial and only 10% is human. That’s 100 trillion microbial cells that we know very little about. Moreover, they are changing all the time based on where we live and what we eat. How can you then target and control what they are doing or not doing?

Health can be better influenced than fixed. There are four factors that cause disease: the patient’s inheritance, environment, physical capacity and psychological state. We don’t tend to catch a cold when we exercise regularly. Our bowel movements are easy when we eat freshly cooked vegetables. We also know that we suffer body aches or fevers when we are stressed. Our body’s inherent tendency is to stay healthy unless disrupted by the above factors.

I spent 20 years as a hypertensive patient popping a pill, only to discover now that my condition is reversing itself through better lifestyle and habits. While I proactively seek doctors and labs to help me track progress of my condition, I don’t use them to find a quick fix so that I can go back to lying on the couch watching TV with a pizza and drink.

As a society, we need to reflect on our mere pursuit of human longevity by using every medical means possible. The healthcare industry needs to rethink its role and simplify its approach to care. The older role entailed waiting for the patient to arrive and fixing problems based on her complaints. When we reverse those lens, the role might mean identifying precursors to problems and helping people maintain their health before they fall sick. It’s time we think about healthcare differently.

Praveen Suthrum is co-founder and President of NextServices, a healthcare technology and management company with offices in Ann Arbor, Michigan and Mumbai, India. Not coincidentally, he is a passionate alumni of the University of Michigan Ross School of Business.

From remote monitoring to telemedicine to unmanned aerial delivery, all the technologies we need to deliver healthcare remotely via the Internet are available today. A variety of portable medical devices measure vital signs (temperature, heart rate, BP, BMI, oximetry and so on). Forget Skype, by next year Ostendo plans to have smartphones beam holograms just as R2-D2 did in Star Wars. Drones are being tested to deliver medical payloads to remote locations. Lab on a chip technology is more of a reality and can detect infectious diseases such as Malaria, Rotavirus, Influenza and so on. And digital stethoscopes, portable ultrasound machines, Internet-enabled otoscopes and retina cameras have been around for awhile.

All we need to do then is re-imagine healthcare delivery by connecting the dots. Let’s do so by first breaking up medicine into six discrete steps.

Six Steps of Medicine:

1. Underlying Indicators: This is when underlying indicators exist but symptoms haven’t manifested sufficiently to cause a patient to seek medical help. For example, a patient may be susceptible to heart disease (e.g. high cholesterol or high BP) but has never had symptoms such as fatigue or chest pain.

2. Visible Symptoms: Here, a patient suffers from mild to traumatic pain/discomfort owing to manifested symptoms. For example, fever is the most common symptom for a variety of diseases. At this step of the process, we do not know why a patient is suffering but we simply know that she is.

4. Core Consultation: A core consultation is when a doctor tries to arrive at a diagnosis from a variety of possible options. Lab tests/CT-scans/radiology tests and so on are also conducted to arrive at as precise a diagnosis as possible.

5. Assessment and Plan: By this step, a doctor makes a clear assessment of the medical problem and prescribes a plan. This involves medications (e.g. antibiotics for an infection) or referring the patient to another specialist (e.g. a cardiologist for further investigation) or further examination.

6. Follow Up: Assuming that the patient follows through with the plan, a follow-up visit assesses the progress made and determines if any changes might be required.

It is these steps that need to be re-imagined and executed remotely removing the need for the doctor and patient to be co-located.

5. EHR software: Other than storing medical records digitally, electronic health records can form a platform integrating data from doctors, patients, various medical devices and tests that make it possible to deliver healthcare remotely. This is the direction we are going with my company’s enki EHR platform.

6. Telemedicine software: Through technologies such as Skype, people are increasingly comfortable interacting over video. See Teladoc, American Well, Doctor on Demand, iKure. Ostendo develops a chip that can bring hologram technology to smartphones that would make a physician-patient virtual interaction more immersive.

7. Analytics software: Medicine is actively becoming a data science subject to analytics and therefore, protocol-driven medicine that can help curb disease at source. For example, population-scale deworming or screening for TB or vaccination protocols. Please see clinical decision support illustrations at Zynx, UpToDate, emerge, Isabel.

Several years ago, Parashuram, an attendant in our office lost his wife (who lived back home in a village) due to a gastrointestinal complication. I tried to get her medical records to doctors in the US but the diagnosis came in simply too late. She died a futile death – like several millions of patients who lack access to a timely diagnosis. That episode changed the direction of our company – it became obvious to me that health data needs to traverse easily and globally and an early diagnosis needs to be arrived at to avoid both costs and complexity.

Given all the technologies that are today available, imagine if a patient had a Health Box, a conceptualization that integrates everything to deliver healthcare remotely via the Internet.

A Simple Visualization: When in need of medical care, the patient or her family presses a button on the Health Box that alerts a contact center, which then patches on a nurse/doctor-on-call via a hologram. Per the doctor’s request, required accessories are plugged in to the Health Box to capture vital signs (e.g. BP, temperature, oximetry) and a physical exam is conducted (e.g. asking a patient to cough and placing the digital stethoscope on a patient’s chest or back). The data is seen in real-time via the EHR. The doctor makes a preliminary medical judgment regarding the next step of care. In case of emergencies, the contact center dispatches a drone to deliver a medical payload at the precise location of the Health Box.

The World Bank estimates that India loses 6% of its GDP (that’s $110B) due to premature deaths and preventable illnesses. This statistic wouldn’t be a whole lot better for any developing country. The developed world has a more nuanced problem – the US also suffers healthcare access, premature deaths and preventable illnesses, perhaps more than the developing world. At the crux of the problem is our inability to stop disease at source. This is what remote healthcare delivery does – encourages patients and healthcare providers to deal with medical problems before they explode in complexity and cost. It’s imperative that we figure this out.

Illustration developed by Swapnil Chafale for representational purposes. Credit as due to creators of respective public images.

When compared to the HIMSS conference that attracted 38,000 people from the healthcare industry, the Health Datapalooza, an event that was organized in Washington, D.C. this week, was relatively low key – about 2,000 people attended it, including folks from the government (one of its organizers). Here’s Todd Park, CTO of the US government introducing the event to entrepreneurs and others.

But interest in similar events could explode as creative companies create meaningful information out of the increasing number of datasets that the government is making public. In a New York Times op-ed, Tom Friedman contemplated a healthcare Silicon Valley that could become a platform for innovation based on health data.

This week, NPR covered Health Datapalooza that is becoming a showcase event to launch apps based on public health data. The story talked about startups that are doing something interesting with Medicare’s recently released datasets: Lyfechannel creates apps that help senior citizens talk to doctors about medical care and Accordion Healthhelps families estimate health expenses. Even a post-graduate fellowship in health data science was launched at the event.

A Public Tool That Reveals Your Doctor’s Intentions

However, the most interesting data visualization from Medicare’s datasets is from ProPublica, a nonprofit that conducts investigative journalism. The tool is called Treatment Tracker.

Being in the revenue cycle business, I was curious to see how the data compared across individual doctors and groups. For any of the 880,000 physicians who submitted claims to Medicare in 2012, the tool shows information on billing, coding and data about their treatment protocols (where did patients go before and after treatment). Spurred by the incentive program, more than 380,000 eligible professionals (mostly doctors) have submitted EHR information in the last three years. Though there’s no wind of it yet, it’s only a matter of time when de-identified health records become public.

This brings a fundamentally different level of transparency to physician services, their behavior and payments. It will compel large EHR vendors who’ve built business models based on hoarding data to become more open. Everything will be out in the sun.

Four Sample Datasets:

RockHealth reported 10 dataset sources that can be used to build a variety of tools and apps. Here are the most interesting ones.

3. openFDA includes reports on drug adverse events, such as adverse reactions or medication errors submitted.

Global Implications

These are early examples of government initiatives to actively make data available in standardized formats for innovation (read about the US DATA act). A search on UK’s OpenData reveals 652 open National Health Service datasets covering statistics from obesity to alcohol consumption. India’s Open Data Initiative has 7,700+ datasetsthat include healthcare datasets covering immunization and disease statistics on AIDS. Over time, most progressive governments will follow the US path and steadily reveal population health data hoping for innovative fixes to healthcare problems.

Wisdom Wanted

There’s a lot of data out there but very little by way of wisdom that can impact how healthcare decisions are made globally. That’s where healthcare entrepreneurs, data analysts and AI algorithms come in. A newer way to understand and present information can bring greater transparency and efficiency, curtailing healthcare fraud and bringing clarity to patient care.

6) Autonomous vehicles (drones) are expected to deliver drugs and other goods remotely (see Matternet). It’s possible to build a basic quadcopter with a camera for $100-200.

7) Patients are increasingly quantifying themselves and comparing their data with others. Example Crohnologyis a social network for Crohn’s Disease patients.

8) Artificial Intelligence is becoming a reality. IBM’s Watson has been training itself at Kettering Cancer Institute. IBM has made Watson available as an API that can be used by other applications. AI-based Google car (I sat in the first version in 2012) actually works quite well!

9) Most patients will have access to an Internet-enabled smart phone or tablet device and it’ll connect from everywhere. Patients will possibly even ‘wear’ a computing device.

10) Most doctors are performing some form of data-enabled, evidence-based medicine (e.g. boom in lab tests) instead of practicing on gut-feel.

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Questions to consider for ambulatory surgery centers

1) Could ambulatory surgery centers expand the ownership of the medical problem from episodic care to the source of the medical problem? For e.g. ASCs focusing on screening for colon cancer can go upstream and identify why its patients are getting colon cancer.

2) Through the aid of EHR data and virtual care, can consults pre-and-post surgery be done remotely? Could new patients be screened virtually, thereby expanding outreach by 10x or more? Outside of the insurance reimbursement model, are there other ways to monetize this? (See American Well that partners with insurances).

3) What would an ASC’s impact on its area of care be if it were to collect and document data from its expanded virtual care model?

4) What would an ongoing multi-variant analysis from different sources with abnormalities reveal for the ASC’s patient population?

5) What role do bio/ genetic markers play in the ASC’s medical area of question? Example, for eye care.

6) Is there a correlation between location and the types of patients seen at the surgery center?

7) What insights could an ASC gain if a large portion of its patients were connected to each other online?

8) What if the EHR was implemented for delivery of healthcare itself in the future and not just as a means of digital storage and quality control?